BMJ Open Gastroenterology最新文献

{"title":"Selective COX-2 inhibitors for short-term musculoskeletal pain in inflammatory bowel disease in remission: a narrative review.","authors":"Michiel A van Nieuwenhoven","doi":"10.1136/bmjgast-2026-002316","DOIUrl":"10.1136/bmjgast-2026-002316","url":null,"abstract":"<p><p>Selective cyclooxygenase-2 (COX-2) inhibitors are often considered when anti-inflammatory analgesia is needed for musculoskeletal pain in patients with inflammatory bowel disease (IBD), but concerns remain about intestinal safety. The clinical evidence on short-term selective COX-2 inhibitor use in IBD, with focus on disease activity outcomes, was reviewed. A prespecified literature search was performed in PubMed and the Cochrane Library supplemented by reference list screening. Clinical trials and clinical studies evaluating celecoxib, etoricoxib or rofecoxib in patients with IBD and musculoskeletal/rheumatological symptoms were considered when gastrointestinal (GI) outcomes were reported. Two placebo-controlled randomised trials did not show higher rates of IBD relapse or symptom aggravation vs placebo during short-term treatment in selected patients, including ulcerative colitis in remission and IBD with rheumatic manifestations. Open-label studies and retrospective series reported variable GI adverse events and occasional symptom worsening, but study populations, baseline disease activity, relapse definitions and follow-up duration differed widely. Overall, the strongest available evidence supports cautious short-term use of selective COX-2 inhibitors in selected patients with IBD in remission when anti-inflammatory analgesia is required. Given the small evidence base and limited follow-up, treatment should be time-limited, use the lowest effective dose and include clinical monitoring.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148435045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal association of constipation and diarrhoea with a subsequent diagnosis of colorectal cancer: a propensity score-matched case-control study using real-world primary care data.","authors":"Ernst W Kolbe, Sarah Krieg, Christoph Roderburg, Sven H Loosen, Andreas Krieg, Karel Kostev","doi":"10.1136/bmjgast-2026-002305","DOIUrl":"10.1136/bmjgast-2026-002305","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated whether chronic constipation and diarrhoea are temporally linked to colorectal cancer (CRC) diagnosis, aiming to clarify if these symptoms function as modifiable risk factors or early indicators of malignancy.</p><p><strong>Methods: </strong>We conducted a retrospective case-control study using real-world data from the German Disease Analyser database. After 1:5 propensity score matching for age, sex, index year and comorbidities, 10 941 patients with CRC and 54 705 matched controls without cancer were included in the study. Documentation of constipation and diarrhoea was evaluated in six time intervals up to 5 years before CRC diagnosis. Multivariable conditional logistic regression was used to calculate ORs and 95% CIs for CRC risk.</p><p><strong>Results: </strong>Constipation was significantly more frequent in patients with CRC within 6 months prior to CRC diagnosis (OR 3.23; 95% CI 2.85 to 3.66). A similar pattern was observed for diarrhoea within 6 months prior to diagnosis. However, the association was stronger the more frequently diarrhoea was documented (at least one diagnosis: OR 3.37; 95% CI 3.03 to 3.75; at least two diagnoses: OR 4.18; 95% CI 3.31 to 5.28; at least three diagnoses: OR 6.82; 95% CI 4.43 to 10.49). No associations were identified beyond 1 year before diagnosis.</p><p><strong>Conclusion: </strong>Constipation and diarrhoea were associated with the subsequent diagnosis of CRC only in the immediate months before diagnosis, suggesting reverse causality rather than a causal relationship. These symptoms may serve as red flags rather than risk factors, emphasising the need for timely diagnostic evaluation, especially in the presence of persistent changes in bowel habits.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Development of an optimal pathway for endoscopic sleeve gastroplasty implementation in the NHS: a modified nominal group technique study.","authors":"","doi":"10.1136/bmjgast-2025-002050corr1","DOIUrl":"10.1136/bmjgast-2025-002050corr1","url":null,"abstract":"","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13343041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver fibrosis in metabolic dysfunction-associated steatotic liver disease: epidemiology, risk stratification and therapeutics.","authors":"Fuliang Li, Hongmei Li, Dulguun Juramt, Kai Kou, Frank Tacke, Lanlan Chen","doi":"10.1136/bmjgast-2026-002343","DOIUrl":"10.1136/bmjgast-2026-002343","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most prevalent chronic liver disease worldwide and is tightly linked to cardiometabolic comorbidities. A major clinical focus on MASLD is the detection of hepatic fibrosis, which most strongly predicts liver-related events, hepatocellular carcinoma risk and mortality. While lifestyle modification and sustained weight loss remain foundational, therapeutic innovation has rapidly expanded, shifting the metabolic dysfunction-associated steatohepatitis (MASH) treatment landscape towards targeted pharmacotherapies that address metabolic stress, inflammation and fibrogenesis, particularly for moderate/advanced fibrosis (<i>i.e.</i>, F2/F3 fibrosis and cirrhosis). This review summarises the burden and systemic complications of MASLD, highlights endocrine influences that modulate hepatic steatosis and disease severity and emphasises the central role of fibrosis staging and non-invasive risk stratification in clinical decision-making. We then synthesise emerging pharmacotherapies across key mechanistic axes, including incretin-based agents (GLP-1 receptor agonists and dual/triple agonists), hepatocyte-directed metabolic modulators (thyroid hormone receptor-β agonists, fatty acid synthase inhibitors, acetyl-CoA carboxylase and other de novo lipogenesis inhibitors), bile acid pathway therapies (FXR agonists) and pleiotropic metabolic-fibrotic regulators (fibroblast growth factor 21 [FGF21] analogues and peroxisome proliferator-activated receptor [PPAR] agonists). We also discuss combination strategies, candidate agents with potential direct antifibrotic activity and the growing role of genetic risk stratification and hepatocyte-targeted oligonucleotide therapeutics. Finally, we outline current surrogate endpoints used in clinical trials and propose future directions towards stage-specific, mechanism-informed and combination regimens to achieve persistent MASH resolution and meaningful fibrosis regression.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interplay between MASLD, obesity and type 2 diabetes: epidemiology, shared pathways and clinical implications.","authors":"Kenneth Tachi, Adwoa Agyei-Nkansah, Yacoba Atiase, Bright Forkuo, Victoria Akosua Agyen-Frimpong","doi":"10.1136/bmjgast-2026-002294","DOIUrl":"10.1136/bmjgast-2026-002294","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD), obesity and type 2 diabetes mellitus (T2DM) are interconnected global epidemics that frequently coexist and mutually reinforce disease progression and adverse clinical outcomes. MASLD, the most prevalent chronic liver disease worldwide, is now recognised as a hepatic manifestation of systemic metabolic dysfunction. The coexistence of the triad markedly accelerates MASLD progression, heightens cardiometabolic risk and shifts mortality patterns towards cardiovascular disease, the leading cause of death in affected populations. However, most available data describe MASLD in association with either obesity or T2DM individually, while robust epidemiological or mechanistic evidence for their combined overlap remains scarce. This review synthesises current evidence on the epidemiological overlap and shared risk architecture linking MASLD, obesity and T2DM. We examine integrated pathophysiological and molecular mechanisms underpinning this triad, including insulin resistance, lipotoxicity, mitochondrial dysfunction, endoplasmic reticulum stress, transcriptional and epigenetic dysregulation and gut-liver axis perturbations. We further discuss the clinical implications of this shared biology, emphasising integrated screening strategies and presenting an evidence-based algorithm for non-invasive identification of advanced hepatic fibrosis within the triad. We review evidence-based therapeutic approaches, including mechanism-based pharmacological therapies, and highlight their differential effects on weight, glycaemic control and liver disease severity. Emerging research priorities and future directions for integrated cardiometabolic care are also outlined. Collectively, the review underscores the need for integrated hepatic-cardiometabolic care to improve clinical outcomes across this metabolic triad.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital self-management programme for pain, fatigue and faecal incontinence in inflammatory bowel disease: cost-effectiveness analysis of the IBD-BOOST randomised controlled trial.","authors":"Chris Roukas, Laura Miller, Fionn Cléirigh Büttner, Thomas Hamborg, Vladimir Sergeevich Gordeev, Vari Wileman, Richard C G Pollok, Sonia Saxena, Rona Moss-Morris, Ailsa Hart, James O Lindsay, Christine Norton, Borislava Mihaylova","doi":"10.1136/bmjgast-2025-002140","DOIUrl":"10.1136/bmjgast-2025-002140","url":null,"abstract":"<p><strong>Objective: </strong>People living with inflammatory bowel disease (IBD) frequently experience abdominal pain, fatigue and faecal incontinence that persist despite optimal medical treatment. This study aimed to assess the cost-effectiveness of IBD-BOOST, a digital, interactive, facilitator-supported self-management intervention targeting these symptoms.</p><p><strong>Methods: </strong>A cost-effectiveness analysis was conducted alongside the IBD-BOOST trial, which randomised people with IBD experiencing fatigue, pain and/or faecal incontinence to the IBD-BOOST intervention (N=391) or care as usual (N=389) over 12 months. While the IBD-BOOST intervention did not significantly improve the primary trial outcome measures (UK Inflammatory Bowel Disease Questionnaire and global rating of symptom relief), trends towards benefit were observed across study outcomes. Therefore, this analysis focuses on secondary health economic outcome measures. The cost of the intervention, including its development, facilitation and delivery, was assessed. Participants reported their health service use, out-of-pocket expenses and time off work over the previous 3 months and their health-related quality of life at baseline, 6-month and 12-month follow-up. Participants' costs (2023 UK£) and quality-adjusted life years (QALYs) over the 12 months were compared between study arms using mixed effects models.</p><p><strong>Results: </strong>The IBD-BOOST intervention resulted in additional per participant 0.016 QALYs (95% CI 0.002 to 0.030) over the 12 months in the study and cost savings of -£304.66 (-803.51 to 194.18) for healthcare and -£39.48 (-388.09 to 309.12) for out-of-pocket costs and time off work over months 4-6 and 10-12. This resulted in cost savings of -£28 633 (95% CI -51 555 to 18 764) and -£33 568 (-64 421 to 26 198) per QALY gained with IBD-BOOST from health services and societal perspectives, respectively, and high probability of cost-effectiveness.</p><p><strong>Conclusion: </strong>The IBD-BOOST intervention is highly likely to be cost-effective for the self-management of pain, fatigue and faecal incontinence in people living with IBD.</p><p><strong>Trial registration number: </strong>ISRCTN71618461.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of indigo carmine chromoendoscopy for detecting gastric cancer and gastric adenoma during upper gastrointestinal endoscopy (INDIGO study): protocol for a prospective multicentre observational study.","authors":"Takeshi Yasuda, Jun Matsubayashi, Hideki Ishikawa, Kohei Takizawa","doi":"10.1136/bmjgast-2026-002404","DOIUrl":"10.1136/bmjgast-2026-002404","url":null,"abstract":"<p><strong>Introduction: </strong>Early gastric cancer is characterised by subtle mucosal and colour changes that frequently lead to missed lesions during routine endoscopy, making detection difficult. Indigo carmine spraying is a classical chromoendoscopic method to enhance mucosal surface irregularities and has been believed to have the potential to facilitate the detection of early gastric neoplasia. This method is widely used in Japan; however, whether it improves gastric neoplasm detection remains unclear. In this prospective study, we aim to evaluate the usefulness of indigo carmine spraying for detecting gastric cancer and gastric adenoma during upper gastrointestinal endoscopy in patients at high risk of gastric cancer.</p><p><strong>Methods and analysis: </strong>This prospective multicentre observational study will include over 30 institutions. Patients undergoing upper gastrointestinal endoscopy for surveillance after endoscopic treatment or pretreatment screening will be enrolled. The age range has been set from 20 years to 95 years, and patients for whom a biopsy will not be feasible will be excluded. Gastric observation will consist of two steps: the first will use white light imaging, followed by a second-pass observation after spraying 20-40 mL of indigo carmine at a concentration of 0.1-0.4%. The primary endpoint will be the proportion of patients with gastric cancer or adenoma lesions detected during the second-pass observation among those who undergo successful indigo carmine examination. A one-sided binomial test (α=0.05) will be used to compare the detection rate with a predefined threshold of 1.0%. We aim to enrol a total of 1050 patients to achieve 80% power.</p><p><strong>Ethics and dissemination: </strong>This study was approved by the Institutional Review Board of Kanagawa Cancer Center (approval number: 2025-92). Written informed consent will be obtained at the time of registration. Following completion of this research, the findings will be promptly compiled and published in appropriate academic conferences and peer-reviewed international journals.</p><p><strong>Trial registration number: </strong>UMIN000059685.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of splenic stiffness measurement for predicting clinically significant varices in children with portal hypertension: a systematic review and diagnostic test accuracy meta-analysis.","authors":"Aditi Kumar, Ranjan Kumar Patel, Vijay Kumar Krishnegowda","doi":"10.1136/bmjgast-2026-002246","DOIUrl":"10.1136/bmjgast-2026-002246","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic accuracy of splenic stiffness measurement (SSM) for detecting clinically significant varices (CSV) in children with portal hypertension (PHTN), including non-cirrhotic portal hypertension (NCPH) and chronic liver disease (CLD).</p><p><strong>Design: </strong>Systematic review and diagnostic test accuracy meta-analysis.</p><p><strong>Data sources: </strong>MEDLINE (via PubMed), Embase and Scopus were searched from inception to 31 July 2025. No language or time limitations were applied.</p><p><strong>Eligibility criteria: </strong>We included prospective and retrospective studies which had children (<18 years) with clinically, radiologically, biochemically or histologically diagnosed PHTN. The index test was SSM (transient elastography, 2D-shear wave elastography (SWE) or point-SWE/acoustic radiation force impulse (ARFI)). The reference standard was oesophagogastroduodenoscopy. Studies with other reference standards, like liver biopsy, were excluded.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted data. A Bayesian random-effects bivariate model was used to estimate summary sensitivity and specificity with 95% credible intervals (CrIs), and hierarchical summary receiver operating characteristic curves were constructed. Risk of bias was assessed using QUADAS-2, and certainty of evidence (COE) was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach.</p><p><strong>Results: </strong>21 studies were included in the systematic review and 14 (n=1027) were eligible for meta-analysis. For CLD (8 studies, n=405), summary sensitivity was 83.0% (95% CrI 69.9% to 91.0%) and specificity was 75.7% (60.8%-85.2%), showing low certainty for CSV. In NCPH (6 studies, n=171), sensitivity for CSV was 92.5% (82.7%-97.0%) and specificity was 80.3% (57.6%-92.7%), with moderate COE for sensitivity and low COE for specificity.</p><p><strong>Conclusions: </strong>SSM probably has high sensitivity and may have moderate specificity for detecting CSV in children with NCPH. In CLD, diagnostic accuracy remains uncertain due to low COE. Further well-designed, aetiology-specific studies are needed to establish the role of SSM in the clinical pathway.</p><p><strong>Prospero registration number: </strong>CRD42024579988.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aetiology and outcomes of emergency admissions for chronic liver disease in England, 2012-2019: a national cohort study using administrative data.","authors":"Jessica King, Cori Campbell, Vikram Bains, James Doidge, Jan Van Der Meulen, Kate Walker, William Bernal","doi":"10.1136/bmjgast-2026-002351","DOIUrl":"10.1136/bmjgast-2026-002351","url":null,"abstract":"<p><strong>Objective: </strong>Chronic liver disease (CLD) deaths in the UK have risen fivefold since 1970. People with CLD often present with advanced disease. We investigated trends in aetiology, care, and outcomes of patients with a first emergency admission (FEA) for CLD in England.</p><p><strong>Methods: </strong>In a retrospective cohort study, we analysed national administrative data of hospital admissions (Hospital Episode Statistics Admitted Patient Care data) to identify patients with a FEA for CLD between April 2012 and March 2019. We used negative binomial, logistic and proportional hazards regression to explore time trends in admission numbers according to population size, demographics, aetiology, readmissions, mortality, transplantation, and the treating clinicians' specialty.</p><p><strong>Results: </strong>There were 83 527 FEAs for CLD during the 7-year study period, with numbers increasing each year. There was no evidence of a time trend when population size was taken into account (p=0.51). Of these FEAs, 65.3% had alcohol-related aetiologies. The proportion of FEAs with viral aetiologies decreased (7.3% in 2012-2014 vs 5.6% in 2016-2019; p<0.001) and metabolic dysfunction-associated steatotic liver disease (MASLD) increased (5.8-11.3%; p<0.001), respectively. Mortality within 30 days was 17.3% and 37.3% within 1 year. 1-year all-cause mortality improved over the study period (2012-2014 vs 2016-2018 adjusted HR 0.92 (95% CI 0.90 to 0.95)) but 30-day readmission rate increased (1.04 (95% CI 1.00 to 1.09)). Over 40% of patients did not receive care from a hepatologist/gastroenterologist during the FEA and <1% received liver transplant within 1 year.</p><p><strong>Conclusion: </strong>The number of patients with FEA for CLD increased in line with population size between 2012 and 2019. The dominant aetiology was alcohol-related, but the proportion with MASLD nearly doubled over the study period. There were improvements in survival, but over a third of patients died within a year, and over a third of hospital survivors were readmitted. Many patients did not receive specialist inpatient care or evidence-based interventions, suggesting opportunities to improve survival and resource use.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-TNF immunogenicity in a Middle Eastern inflammatory bowel disease cohort: prevalence, predictors and context-specific drug level thresholds.","authors":"Shaima Wasim Khan, Noorah Al Hosani, Thaer Khaleel Swaid, Mazin M Edan, Mohammed Nabil Quraishi","doi":"10.1136/bmjgast-2026-002347","DOIUrl":"10.1136/bmjgast-2026-002347","url":null,"abstract":"<p><strong>Objective: </strong>Anti-tumour necrosis factor (anti-TNF) immunogenicity remains a major barrier to treatment persistence in inflammatory bowel disease, yet data from Middle Eastern populations are lacking. We characterised immunogenicity rates, predictors and loss of response mechanisms in a real-world cohort.</p><p><strong>Methods: </strong>This retrospective cohort study included 314 anti-TNF treatment courses (212 infliximab, 102 adalimumab) in 248 patients at a tertiary centre in the United Arab Emirates. Immunogenicity was defined by detectable anti-drug antibodies on a drug-tolerant electrochemiluminescent bridging immunoassay with acid dissociation. Drug levels, predictors and loss of response mechanisms were analysed.</p><p><strong>Results: </strong>Immunogenicity developed in 28.3% (89/314) of courses over median follow-up of 24.0 months (median time to detection 15.0 months, IQR 8.0-36.0). Infliximab and adalimumab had comparable rates (26.9% vs 31.4%; p=0.425). Immunogenicity-mediated failure was the leading cause of discontinuation (48.4%). Pre-event trough levels were significantly lower in immunogenic courses (median 3.0 vs 14.0 mcg/mL; p<0.001). Exploratory receiver operating characteristic thresholds of 5.3 mcg/mL for infliximab (area under the curve (AUC) 0.880) and 6.4 mcg/mL for adalimumab (AUC 0.861) predicted immunogenicity with high discrimination. On shared frailty Cox regression, prior surgery was the strongest predictor (HR 1.85, 95% CI 0.94 to 3.64; p=0.074). A sensitivity analysis excluding rescued patients strengthened the surgery signal (HR 2.80, 95% CI 1.41 to 5.56; p=0.003). Subcutaneous infliximab showed lower immunogenicity than intravenous infliximab (new starters 1/25 (4.0%), switchers 1/33 (3.0%) vs IV 57/212 (26.9%)); after propensity score matching on five covariates, the difference remained significant (3.8% vs 18.3%; p=0.013), though a new starters-only analysis did not reach significance (p=0.062).</p><p><strong>Conclusion: </strong>Immunogenicity patterns in this Middle Eastern cohort are consistent with Western data, supporting pharmacokinetic rather than population-specific determinants. These findings suggest a potential benefit of proactive therapeutic drug monitoring and that subcutaneous infliximab may offer an immunogenic advantage warranting prospective validation.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}